Chicago researchers surveyed patients at a clinic treating sexually transmitted diseases about condom use, perception of HIV risk, and acceptance of PrEP (pre-exposure prophylaxis, the use of medication to prevent HIV infection).
At ICAAC, they presented an analysis of 359 heterosexuals deemed at high risk for HIV infection and found that the vast majority (84%) saw themselves as being at no or low risk of HIV infection.
The two risk factors that were significantly different between the men and the women were having ever been in a jail or prison (55% of men and 23% of women) and having ever exchanged sex for money or drugs (6%of men and 15% of women).
HIV specialist Dr. Kimberly Y. Smith of Rush University Medical Center, one of the leaders of this study, said that women may not recognize that incarceration increases the risk of HIV for their male sex partners and in turn, for the women themselves. The women don't want to believe that their male partners are engaging in sex with other men while incarcerated, whether consensual or not, nor do they recognize other incarceration risk factors such as sharing needles for drug use or tattooing.
Dr. Smith said that when talking with heterosexual or bisexual men who have been incarcerated or have HIV, they will often have kept their sexual contact with other men or their HIV infection a secret from female sex partners.
According to U.S. government data, the prevalence of AIDS among U.S. prisoners is three times that of the general population, and approximately one in five people with HIV will be incarcerated at some point. A factsheet from the Centers for Disease Control and Prevention (CDC), states that incarceration risk factors of unsafe tattooing, sex, and drug use "coupled with the sexual relationships and socioeconomic consequences faced by persons with histories of incarceration, make prisons a risk factor for HIV infection."
The majority of the individuals surveyed in Chicago were people of color (75% black and 15% Latino). In this public clinic (CORE Center), there was a high level of poverty: nearly half (45%) had household incomes of less than $499 a month. Only a third of them were employed and 79% had only a high school education or less.
Half of the 234 men in this study had two or more sex partners in the month before being surveyed, including at least one new sex partner in that time period.
The majority of participants also reported high levels of inconsistent condom use (81 to 96%), with both vaginal and anal intercourse. One-fifth (21%) of both men and women reported having had anal intercourse.
Other risk factors included drinking alcohol or using drugs at least half of the time when having sex, and having a sexually transmitted infection (STI) within the past year.
Some risk factors were based on a partner's behavior (STI within past year; ever exchanging sex for money or drugs; drug use within past 30 days; and ever being in jail or prison).
When asked about taking medication for the prevention of HIV, 83% of the participants said they would take a pill for PrEP. Their preference for taking PrEP was lowest for daily use (63%) and 75% preferred taking it an hour before sex, a day before sex, or a week before sex.
Among the audience at the presentation were doctors who thanked the researchers for reminding everyone that women engage in anal sex and who pointed out that surveys of gay and bisexual men have also found low perceptions of HIV risk in the face of risky behavior or actual infection. One audience member questioned the perception of low risk in light of the fact that these individuals were being seen in an STI clinic. Presenter Dr. Thana Khawcharoenporn said the participants showed a disassociation between their high level of knowledge of risk factors and the assessment of their own risk.
Included in the presentation was information on an earlier study by Denise Dion Hallfors and colleagues that found blacks in the U.S. are at higher risk of HIV despite normative (the same) behavior as whites, that they perceive themselves to be at low risk based on their own actions instead of the risk behaviors of their sex partners, and that the perception of low risk may be associated with ongoing risky behavior and lack of prevention strategies.
Kudos to the researchers at Rush, CORE Center, and Stroger Hospital (Chicago's public hospital) for gathering this information.